| NPI | 1609219187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNATHON JOSEPH HALE Owner 304-465-5361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV WV3858) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2013-04-29 |